Affix securely Passport size Photograph here ' ZIMBABWE MINISTRY OF HIGHER AND TERTIARY EDUCATION, SCIENCE AND TECHNOLOGY DEVELOPMENT STUDENT LOAN APPLICATION SELECTION CRITERIA FORM _ +. Please read this Form before completing it When you have completed’ this application form, please submit it through your State University/ Polytechnic/ Teachers College/ Industrial Training College Applicant will be disqualified for providing any false information CONDITIONS RELATING TO THE LOAN APPLICATION SELECTION CRITERIA 1. (I)_ Section A to be completed by the Student (ii) Section B to be completed by the Parent/Guardian/Loan Guarantor (iil) Section C to be completed by the Institution. 2. The student must be a citizen of Zimbabwe. The surety must be a permanent resident or citizen of Zimbabwe. 3. Loans are meant to assist, first and foremost, needy students. 4, Payment of loans to the student shall cease if conduct, attendance or performance is unsatisfactory. In such cases, loans advanced together with interest accrued shall be repayable forthwith. 5, Repayment of loan shall be within one (1) year from the date money ds borrowed otherwise next application will not be considered. SECTION A: Student Particulars (To be completed by the Student) 1. Names (Surname): Gender: 2. Date of Birth 3. Marital Statu: 4, Residential Address ee 6. x Email Address: Page 1 of 68. Personal Mobile Number(s): a Are you a citizen of Zimbabwe? 10. National I, D. Number: 11. Passport Number: 12. Last School Attended: 13. Highest Qualifications 14. Next of Kin 1 Relationship to Student .... Residential/Physical Address Profession Full Names ‘Address Contact Mobile Number(s) Email Address (if applicable) Next of Kin 2 Relationship to Student Residential/Physical Address Profession Full Names Emall Address (if applicable) 15. If the next of kin lives in the Rural Areas, please supply the following information: Name of Village .. Name of Village Head Name of Chief .. Province Nearest Police Station Nearest School .... 16. YEAR | SUBJECT GRADE OF PASS. EXAMINING : BODY “O” LEVEL | SCHOOL | “A” LEVEL | SCHOOL Page 20f617, _ Details of the Guarantor Full Names Residential Address Postal Address Mobile Number(s) Email Address .. Name of Village Name of Village Head Name of Chief ... Nearest Police Station ... Nearest School District .. Province If you were supported by BEAM or any other charitable organisation, please attach proof from the last school, signed and date stamped by the Ministry of Primary and Secondary Education administrative systems. 18. PARTICULARS OF PROPOSED COURSE (attach offer letter and/or fees invoice and last result slip) Name of Institution .... Programme (Certificate, Diploma, Degree) .. Faculty/Department: Duration of Course in Years . Semester/Term you will be entering Date Course Commences .. Year of Completion Please note that all approved loans shall be paid directly to the accounts of Institutions, balance to be paid to the student's account STUDENT BANKING DETAILS Name of Accou 19, DECLARATION BY STUDENT L .. am applying for a Loan of to further my studies. I am unable to pay for my fees on my own because of the following reasons: (Provide or attach proof/evidence where necessary) Page 3 of 6I declare that the information I have provided is, to the best of my knowledge and belief, correct. I further declare that any false information that I supplied automatically nullifies this application. ... Mobile No: .... Date: Signature of Student: Full Names of Witness Signature of Witne: Full Names of Witness 2: LD. Number: Signature of Witness: .. Mobile No: Date: . SECTION B: PARTICULARS OF PARENT/GUARDIAN (To be completed by parent/guardian/spouse) PARENT /GUARDIAN/SPOUSE ae a No Full Names (Surname First) . Relationship to student .. Residential Address Postal Address Current Physical Address If Parent/guardian/spouse lives in the Rural Areas: Name of Village Name of Village Head Name of Chief .. District .. Province Nearest Police Station Nearest School .... National I.D. Number: Occupation (a) Formal Employment Name and Address of Employer Salary per month ... (Attach latest pay slip) (b) Self-Employment State nature of self-employment and the location where you usually carry out this business Other sources of income Page 4 of 68. Bank-details’of suret Account Name: Account Number: Bank Name: Branch: .. oR Eco Cash/Tele Cash/One Money Number: 9. Mobile Number(s): 10, Are you a citizen of Zimbabwe? ... 11. Are* you resident in Zimbabwe? If not, state country of residence 12. State any movable/immovable property (e.g. house, cattle, vehicle etc) declare that the above I . to the best of my knowledge and belief, true and correct. information is, Date: Signature: SECTION C: COMMENTS BY THE INSTITUTION LOAN SELECTION COMMITTEE. 1, Is the information from the student the same with that provided by the parent/guardian/loan guarantor? ... Recommended/Not Recommended (Justify) airperson of the Selection Committee Signature Page 5 of 6BANK DETAILS OF THE INSTITUTION: Account Name: ‘Account Number: Bank Name: .. Branch: .. * OFFICIAL DATE STAMP Page 6 of 6